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Pathologies ADULTS > lungs > Flashcards

lungs Flashcards

1
Q

What is pneumothorax and when does it occur?

What is a typical presentation of pneumothorax?

A
  • Occurs when air gets into plural space, separating the lung from chest wall.
  • It can be spontaneous, trauma
  • typical presentation is tall thin young man with sudden breathlessness and pleuritic chest pain, possibly when playing sport
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2
Q

What is the management for pneumothorax?

A
  • Aspiration if shortness of breath and above 2cm of air.
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3
Q

What forms the triangle of safety for chest drains?

A
  • 5th intercostal space (inferior to nipple)
  • Midaxillary line (lateral edge of latissimus dorsi)
  • Anterior axillary line (lateral edge of the pectoralis major)
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4
Q

What are the two key complications of chest drains?

A
  • Air leaks around drain site

- surgical emphysema/subcutaneous emphysema

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5
Q

What is tension pneumothorax and how is it caused?

A

Caused by trauma to the chest wall that creates a one-way valve that lets air in but NOT out of the pleural space.

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6
Q

What are the signs of tension pneumothorax?

A
  • Tracheal deviation away from the side of pneumothorax
  • reduced air entry to affected side
  • increased resonance to percussion on the affected side
  • Tachycardia
  • Hypotension
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7
Q

Management of tension pneumothorax?

A
  • Insert a large bore cannula into the second intercostal space in the midclavicular line.

Once pressure in relieved with cannula, insert chest drain

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8
Q

What are the two main types of lung cancer?

A
  • Non-small cell lung cancer

- Small cell lung cancer (SCLC)

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9
Q

The subtypes under non-small cell lung cancer?

A
  • Adenocarcinoma (most common)
  • Squamous cell carcinoma
  • Large-cell carcinoma
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10
Q

What is SCLC responsible for? and why is that?

A

It is responsible for multiple paraneoplastic syndrome. This is because SCLC contain neurosecretory granules that release neuroendocrine hormones.

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11
Q

What are the signs and symptoms of lung cancer?

A
  • SOB
  • cough
  • Haemopytysis (coughing up blood)*
  • Finger clubbing
  • recurrent pneumonia
  • weight loss
  • Lymphadenopathy (often supraclavicular nodes)
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12
Q

What findings on a chest xray suggest lung cancer?

A
  • Hilar enlargement
  • Peripheral opacity (visible lesion in the lung field)
  • pleural effusion (usually unilateral in cancer)
  • collapse
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13
Q

What does a PET-CT (positron emission tomography) do?

A

The scan involves injecting radioactive tracer to visualise how metabolically active various tissue are (using CT scanner and gamma ray detector) - usually shows areas that cancer spread by showing increased metabolic activity suggestive of cancer.

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14
Q

What is the first line treatment for non-small cell lung cancer?

A

SUGERY- Lobectomy is first-line.

Segmentector or wedge resection is also another option.

Radiotherapy can help when early enough.

Chemotherapy offered alongside surgery or radiotherapy. Can also be used for palliative.

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15
Q

What is the treatment for SCLC?

A

chemotherapy and radiotherapy.

*Prognosis is worse in SCLC than non-small cell lung cencer.

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16
Q

What are some of the complications of lung cancer?

A
  • recurrent laryngeal nerve palsy: present with hoarse voice, caused by cancer pressing on or affecting the recurrent laryngeal nerve as it passes through the mediastinum.
  • phrenic nerve palsy: due to nerve compression causing diaphragm weakness and presents are shortness of breath.
  • SVC obstruction: direct compression of tumour on SVC. presents with facial swelling, difficulty breathing and distended veins in the neck and upper chest. Pemberton’s sign
  • Horner’s syndrome: caused by Pancoast’s tumour (tumour in the pulmonary apex) pressing on the sympathetic ganglion.
  • Syndrome of inappropriate ADH (SIADH) caused by ectopic ADH secretion by a small cell lung cancer and presents with hyponatraemia.
  • Cushings syndrome caused by ectopic ACTH secreted by SCLC.
  • Hypercalcaemia: causes by ectopic parathyroid hormone from the squamous cell carcinoma.
  • Lambert-Eaton Myasthenic syndrome
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17
Q

What is a pemberton’s sign?

A

is where raising the hand over the head causes facial congestion and cyanosis.

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18
Q

What is pneumonia and how is it seen in an x-ray?

A

Infection of the lung tissues and seen as consolidation on chest x ray.

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19
Q

What are the 3 classification of pneumonia?

A
  • Community acquired pneumonia.
  • Hospital acquired pneumonia
  • Aspiration pneumonia.
20
Q

What are the presentations of pneumonia?

A
  • Shortness of breath
  • Cough productive of sputum
  • fever
  • haemoptysis
  • pleuritic chest pain (sharp chest pain on inspiration)
  • Delirium
  • sepsis
21
Q

What signs of pneumonia can indicate sepsis secondary?

A
  • Tachypnoea
  • Tachycardia
  • Hypoxia
  • Hypotension
  • fever
  • confusion
22
Q

What are the characteristic chest signs of pneumonia?

A
  • Bronchial breath sounds (especially loud on inspiration)
  • Focal coarse crackles
  • Dullness to percussion (due to lung tissue collapse and/or consolidation)
23
Q

What scoring system is used for pneumonia?

A

CURB-65

C- confusion
U - Urea above 7
R- resp above 30
B - hypo 
65 - above 65 age
24
Q

What are the common causes of pneumonia?

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae

Other causes:

  • Moraxella catarrhalis: immunocompromised patients or with chronic pulmonary disease.
  • Pseudomonas aeruginosa: patients with cystic fibrosis or bronchiectasis
  • Staphylococcus aureus: Patients with cystic fibrosis.
25
Q

What is atypical pneumonia? What is used to treat it?

A

pneumonia caused by organism that cannot be cultured.

DO NOT respond to penicillin - Only treated with macrolides, fluroquinolones or tetracycline

26
Q

What are the 5 causes of atypical pneumonia?

A

1) Legionella pneumophilia: cause low sodium
2) Clamydia psittaci: from birds
3) Mycoplasma pneumoniae: can cause erythema multiforme (pink rings with pale centre)
4) Chlamydophilia pneumonia: presentation of school aged child with mild to moderate chronic pneumonia with wheeze.
5) Coxiella burnetii (Q fever): farmers, exposure to animals and other bodily fluids.
* Legions of psittaci MCQs*

27
Q

Who is fungal pneumonia (pneumocystis jiroveci (PCP)) seen in? and what does it present with?

A

Immunocompromised patients particularly patients with newly HIV or with low CD4 count.

Presents with dry cough without sputum, shortness of breath on exertion and night sweats.

28
Q

What is the treatment for fungal pneumonia?

A

Co-trimoxazol (trimethoprim/sulfamethoxazole) known by the bran name “septrin”.

Patients with low CD4 counts are prescribed prophylactic oral co-trimoxazole to protect againts PCP.

29
Q

How any days after administration of antibiotic do you repeat WBC and CRP for pneumonia?

A

3 days

30
Q

What is asthma?

A

Chronic inflammatory condition of airways that causes episodic exacerbation of bronchoconstriction - narrowing of airways causes obstruction of airflow in and out

31
Q

What is a typical presentation for asthma diagnosis?

A
  • episodic symptoms
  • worse at night
  • Dry cough with wheeze and shortness of breath
  • History of atopic conditions
  • Family history
  • Bilateral widespread “polyphonic” wheeze heard by healthcare professional
32
Q

what some of the atopic conditions?

A
  • Eczema
  • Hayfever
  • food allergies
33
Q

What can unilateral wheeze suggest?

A

focal lesion or infection

34
Q

What does exudative and transudative mean? (Pleural effusion)

A

Exudative - high protein count (>3g/dL)

Transudative - Low protein count (<3g/dL)

35
Q

What causes exudative pleural effusion?

A

Inflammation - as it results in protein leakage from tissues into pleural space. Causes of inflammation include lung cancer, pneumonia, rheumatoid arthritis and TB

36
Q

What causes transudatuve pleural effusion?

A

Caused by fluid shifting - congestive heart failure, Hypalbuminaemia, hypothyroidism and Meig’s syndrome

37
Q

What is Meig’s syndrome?

A

Right sided pleural effusion with ovarian malignancy

38
Q

What are the presentation of pleural effusion?

A

SOB, dullness to percussion over effusion, reduced breath sounds and tracheal deviation away from massive effusion

39
Q

What is seen on a chest xray for pleural effusion?

A
  • Blunt costophrenic angle
  • fluid in lung fissures
  • Larger effusions will have a meniscus. This is a curving upwards where it meets the chest wall and mediastinum.
  • Tracheal and mediastinal deviation if it is a massive effusion
40
Q

What does the aspiration or chest drain of pleural fluid analyse for?

A

Protein count, cell count, pH, glucose, LDL and microbiology testing

41
Q

What are the treatment options for pleural effusion?

A

Conservative management for small ones and pleural aspiration (temporary and many need to repeat it) or chest drain (prevent recurrence) for massive effusion.

42
Q

What is an empyema? What would the pleural aspiration show? How do you treat empyema?

A

infected pleural effusion, suspect in patients with improving pneumonia and fever.

Pleural aspiration show pus, acidic pH, low glucose and high LDL.

Treatment- chest drain to remove pus and antibiotics

43
Q

What are the british thoracic society/Sign guidlines for the diagnosis for asthma?

A

Basically suggest to make clinical diagnosis when there is high clinical suspicion of asthma and testing when there is an intermediated or low clinical suspicion.

Intermediate: spirometry with reversibility testing
Low: referral and investigating other causes of symptoms.

44
Q

What does type 1 resp failure result in?

A

Hypoxemic - low oxygen levels and normal or low carbon dioxide.

arterial paO2 is low with normal or low arterial paCO2.(ABG results)

45
Q

What does type 2 resp failure result in?

A

Hypercapnic - insufficency excreting CO2 and therefore accumulate.

ABG - low paO2 and normal or high paCO2.

Pathologies ADULTS (9 decks)

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